HomeMy WebLinkAbout1916-zNO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y,
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ~/¢..tte~.th..~t..&.,~f/~..~,,[..R.,~... Street
Map No. ~ .......... Block No....~,Ig~ ....... Lot No....~ ....... J~eO~¢t...N,.~t, ........ ~ ....... r ....
conform~ substantially to the Application for Building Permit heretofore filed in this office dated
........................ 00.toT~e~.....3.~. .............. , 19~2... pursuant to which Building permit No.
dated ..................... ~.....~ ...... , 19.(~2..., was issued, and conforms to all of the requirements
of the appIicable provisions of the law. The occupancy for which this certificate is issued is ........
· ,~ts ~,ae.a s...brai 3_~i~g...~... ~o~oz'....t,~.~...te~.~t~l.. ~.. gar. age ........................................
The certificate is issued .to .~.t.e¥'e..~..~.~.~3o~[.....;. .............. .~ ......................................
[owner, essee or tenant)
of the aforesaid building.
Building Inspector J
FOI~M NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.° 1916' Z
Date ....................... ~lt~.....'l .~. ........ 196i~....
Permission is hereby granted to:
..~outhold ..........................................................
to..lh~.l.d...al~..a~d .i.t Sen.. ~.. ~..~..st.i.n~.. ~utSne s~ · .~u~k.]:d 4_.n~ ..................................
at premises located at ....S/8...l~dd3be..~o~d.t....Ne~t,...L~,.]:,p,R .....................................................
pursuant to application dated ............................... 0~.t,,O~:~.....~,~ ....... 19.6~,.., and approved by the
Building Inspector
Fee $...~', O~ ...........
Building Inspector
FOI~M NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .......~ ....... !.?.....,19 ........ (~ ~
Approved ........................................ , 19 ........ Permit No .................................
Disapproved a/c .................................................................
nspeetor)
Application No...]...~..I....~ .............
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d, Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such
permit shall be kept on the premises available for inspection throughout the progress of the work.
e. No building shall be occupied or used in whole or in po rt for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
~Xre of a~e, if a corporation)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, ptumber or builder.
owner of premises ...~...,~/,~./~K' ..~ ....................... ' ........................................................
Name
of
If applicant is a corporate, signature of duly authorized officer.
-~-~ -{Name an~l titl~ ~lrcorl~orat~ officer)~
1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: ....................
Street and Number/~,. · ." .,~...., .~ .~.. ........ ~u~ni~~ ...... ,4.~¢; ...................................................
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
use and occupancy ..'~.....~......~.....//~~....~...../~..:~--.*...~.. .......................................
b.
Intended
/
3. Nature of work (check which applicable): New Building .................. Addition .....~ ....... Alteration
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4. Estimated Cost ........... ~...~....~...~ ........................ Fee ......... ..'~.~...~ ...................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units .............................. Number of dwelling units on each floor ............................
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................
7. Dimensions of existing structures, if any: Front.....~,....'~... .........Rear ..~...~.. .............. Depth~.'~...'.'K. ......................
Height ....~,,.....~... ............ Number of Stories ....... ~ ....................................................................................................
Dimensions of same structure with alterations or additions: Front ....... ..~.....~.. ................ Rear ...~ .~.. ......................
Depth ..J~....~.. ................. Height ........... :: ................... Number of Stories .........'. ..............................
8. Dimensions of entire new construction: Front ................................ Rear ............................ Depth ............................
Height ............................ Number of Stories ..................................
9. Size of lot: Front ..j.,Z..~:~ ................. Rear ............................ Depth ..... ~.~...~...~.. .........................
10. Date of Purchase ........................................................ Nome of Former Owner ....................................
11. Zone or use district in which premises ore situated ......... -:~.'.~..~ .........................................................
12. Does praposed construction ~iolote ant zoning law, ordinance az regulation? ......................................................
13. Name of Owner of premise~-k~.....~:.~T.~Z:.F.T.L..Address ................................. .4.: ....... Phone No .....................
Name of Architect ..... ; ............... ~.: .............................. Address ....... :~.....~ ................. Phone No .....................
Name of Contractor/.~.~'..L..~..:.~..?..~.~...-'~....-Address ....~-~-~..[~.-' Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from
property lines. Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW~.O~J<~'. ,~_~, ) c c ,~
.. _
.................... ~~.....~eing~--- duly sworn, deposes and says that he is the ~p~ icant
(Name of individual siDnin~~~ ·
above named He is the ........... ~ ......~~~~....:: .......... : ..........................................................................
(Controctar, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform ar have performed the said work and to make and file
this ~plication; that all statements contained in this application are true to the best of his knowledge arid belief;
and that the work will be performed in the manner set foct~j~he apph~hon filed therewith. /
Sworn to befor me this , JUdiTH F. ~c
................ .............................